{
"Npi": {
"NPI": "1699890103",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ROBERT W MOSES OD PROFESSIONAL CORP.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "618 N FRONT ST",
"SecondLineMailingAddress": "SUITE A",
"MailingAddressCityName": "HEBRON",
"MailingAddressStateName": "IN",
"MailingAddressPostalCode": "46341-9205",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "219-996-2800",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "618 N MAIN ST",
"SecondLinePracticeLocationAddress": "SUITE A",
"PracticeLocationAddressCityName": "HEBRON",
"PracticeLocationAddressStateName": "IN",
"PracticeLocationAddressPostalCode": "46341-8710",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "219-996-2800",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/21/2007",
"LastUpdateDate": "10/12/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MOSES",
"AuthorizedOfficialFirstName": "ROBERT",
"AuthorizedOfficialMiddleName": "WILLIAM",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "OD",
"AuthorizedOfficialTelephoneNumber": "219-736-2020",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332H00000X",
"TaxonomyName": "Eyewear Supplier",
"LicenseNumber": "18001579",
"LicenseNumberStateCode": "IN",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}